Thank you for your inquiry about CMS127v10 Pneumococcal Vaccination Status for Older Adults. The measure requires documentation of a pneumococcal vaccination received on or after a patient's 60th birthday and before the end of the measurement period. The measure logic uses the attribute called "relevantDatetime", which references the point in time the immunization is administered, or the time the procedure is performed. The date of the numerator event must be documented specifically enough to determine it is within the appropriate timeframe of before the end of the Measurement Period. The measure requires documentation via QDM v5.5 datatypes "Immunization, Administered" with any codes listed in the "Pneumococcal Polysaccharide 23 Vaccine" value set (2.16.840.1.113883.3.464.1003.110.12.1089), or "Procedure, Performed" with the CPT Code (90732) "Pneumococcal polysaccharide vaccine, 23-valent (PPSV23), adult or immunosuppressed patient dosage, when administered to individuals 2 years or older, for subcutaneous or intramuscular use". A patient may also meet the numerator criteria if they have documentation via QDM v5.5 datatype "Diagnosis" with the SNOMEDCT code "Adverse reaction to vaccine product containing Streptococcus pneumoniae antigen (disorder)" and a "prevalencePeriod" indicating diagnosis starting on or before the end of the measurement period. Self-reported vaccinations are accepted if the above information is documented in a structured field in the EHR, approved for entry by the provider. There is a note in the guidance that indicates that patient self-report for procedures as well as immunizations should be recorded in 'Procedure, Performed' template or 'Immunization, Administered' template in QRDA-1 . For additional guidance on reading or implementing eCQMs, you may refer to available resources on the eCQI Resource Center: https://ecqi.healthit.gov/ep-ec?qt-tabs_ep=0&globalyearfilter=2022 .